Short-term outcomes and long-term quality of life after undergoing radical proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis for Siewert type II and III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis / 中华胃肠外科杂志

Objective: To evaluate the effects on short-term clinical outcomes and long-term quality of life of laparoscopic-assisted radical proximal gastrectomy with esophageal gastric tube anastomosis versus total gastrectomy with Roux-en-Y anastomosis for adenocarcinoma of the esophagogastric junction. Methods: This was a propensity score matching, retrospective, cohort study. Clinicopathological data of 184 patients with adenocarcinoma of the esophagogastric junction admitted to two medical centers in China from January 2016 to January 2021 were collected (147 in the First Affiliated Hospital of Xiamen University and 37 in the Affiliated Hospital of Qinghai University). All patients had undergone laparoscopic-assisted radical gastrectomy. They were divided into two groups based on the extent of tumor resection and technique used for digestive tract reconstruction. A proximal gastrectomy with reconstruction by esophageal gastric tube anastomosis group comprised 82 patients and a total gastrectomy with reconstruction by Roux-en-Y anastomosis group comprised 102 patients. These groups differed significantly in the following baseline characteristics: age, preoperative hemoglobin, preoperative albumin, tumor length, tumor differentiation, and tumor TNM stage (all P<0.05). To eliminate potential bias caused by unequal distribution between the two groups, 1∶1 matching was performed by the nearest neighbor matching method. The 13 matched variables comprised sex, age, height, body mass, body mass index, preoperative glucose, preoperative hemoglobin, preoperative total protein, preoperative albumin, neoadjuvant radiotherapy, tumor length, degree of differentiation, and pathological TNM stage. Postoperative complications, postoperative nutritional status, incidence of reflux esophagitis 1 year after surgery, and quality of life were compared between the two groups. Results: After propensity score matching, 60 patients each were enrolled in the proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis groups. The baseline characteristics were comparable between these groups (all P>0.05). There were no significant differences between the two groups in operative time, intraoperative bleeding, time to semifluid diet, postoperative hospital days, tumor length, and total hospital costs (P>0.05). Patients in the proximal gastrectomy with esophageal gastric tube anastomosis group had earlier postoperative gastric tube and abdominal drainage tube removal time than those in the total gastrectomy with Roux-en-Y anastomosis group (t=-2.183, P=0.023 and t=-4.073, P<0.001, respectively). In contrast, significantly fewer lymph nodes were cleared and significantly fewer lymph nodes were positive in the proximal gastrectomy with esophageal gastric tube anastomosis group than in the total gastrectomy with Roux-en-Y anastomosis group (t=-5.754, P<0.001 and t=-2.575, P=0.031, respectively). The incidence of early postoperative complications was 43.3% (26/60) in the total gastrectomy with Roux-en-Y anastomosis group; this is not significantly higher than the 26.7% (16/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=3.663，P=0.056). The incidences of pulmonary infection (31.7%, 19/60) and pleural effusion (30.0%, 18/60) were significantly higher in the total gastrectomy with Roux-en-Y anastomosis group than in the proximal gastrectomy with esophageal gastric tube anastomosis group (13.3%, 8/60 and 8.3%, 5/60, respectively); these differences are significant (χ2=8.711, P=0.003 and χ2=11.368, P=0.001, respectively). All early complications were successfully treated before discharge. The incidence of long-term postoperative complications was 20.0% (12/60) in the total gastrectomy with Roux-en-Y anastomosis group and 35.0% (21/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this difference is not significant (χ2=3.386，P=0.066). The incidence of reflux esophagitis was 23.3% (14/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this is significantly higher than the 1.7% (1/60) in the total gastrectomy with Roux-en-Y anastomosis group (χ2=12.876, P<0.001). Body mass index had decreased significantly in both groups 1 year after surgery compared with preoperatively; however, the difference between the two groups was not significant (P>0.05). The differences in hemoglobin and albumin concentrations between 1 year postoperatively and preoperatively were not significant (both P>0.05). Quality of life was assessed using the Visick grade. Visick grade I dominated in both groups. The percentage of patients with Visick II and III in the total gastrectomy with Roux-en-Y anastomosis group was 11.7% (7/60), which is significantly lower than the 33.3% (20/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=8.076, P=0.004). No patients in either group had a grade IV quality of life. Conclusions: Both proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis laparoscopic-assisted radical surgery for adenocarcinoma of the esophagogastric junction are safe and feasible. However, both procedures have their own advantages and disadvantages in terms of postoperative complications. The incidence of reflux esophagitis is higher after proximal gastrectomy with esophageal gastric tube anastomosis, whereas the long-term quality of life is lower than that of patients after total gastrectomy with Roux-en-Y anastomosis.

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With continuous increases in the amount and duration of plastic film used, the residual film in farmland soil is accumulated and tended to be fragmented, which affects soil water infiltration. We carried out an experiment of one-dimensional vertical infiltration of soil moisture. We examined the effects of different residual film density and area on soil water cumulative infiltration under 21 experimental treatments with 5 residual film area levels (0.25, 0.5, 1, 2, 8 cm2) and 5 residual film density levels (0, 60, 180, 300, 420 kg·hm-2). The results showed that soil water infiltration rate was accelerated and the total infiltration amount was increased by adding a certain amount of residual film into the clay loam soil with bulk density of 1.53 g·cm-3. The total infiltration amount of different residual film area always appeared mutation or turning point when the single residual film area was 1 cm2. When the residual film area and density were larger or smaller than that, the cumulative infiltration amount would be significantly affected, with the treatment of 0.5 cm2 residual film area and 200 kg·hm-2 residual film density being obvious demarcation. When the residual film area was 0.25 cm2, the cumulative infiltration reached the maximum. When the residual film with a single area ≤0.25 cm2 was uniformly mixed into the soil, the slope of soil water cumulative infiltration curve was significantly different from that of other residual film treatments, forming a "new structure" soil with unique water infiltration characteristics.

Mechanism of Saline-Alkali land improvement using subsurface pipe and vertical well drainage measures and its response to agricultural soil ecosystem.

Salinization is recognized as a threat to agricultural productivity and land resources in global arid desert regions. To date, field soil improvement schemes have met with minimal success to date. We aimed to improve saline-alkali soils by assessing the effects of combining subsurface pipe (Pa) and vertical well (Sa) drainage measures on agricultural soils ecosystem. In a five-year field experiment, soil was sampled 0.5 m, 5 m, 7.5 m horizontally away from the Pa, and 0.5 m, 30 m, 60 m horizontally away from the Sa. Findings indicate that the soil electrical conductivity (EC) decreased from 16 dS m-1 to 3 dS m-1 at a 0-80 cm depth, and the soil desalination efficiency was great at the 0-300 cm depths (≥ 32%) than at the 400-700 cm depths (-14%-74.7%). The combined Pa and Sa drainage measures significantly decreased the species richness and quantity of soil microbial communities, and their negative impact on observed species was irreversible within 1 year. The farther the horizontal sampling conducted from the Pa and Sa, the greater the structural similarity of the microbial community at the genus level, higher the catalase, acidic protease, and neutral phosphatase activities, and lower the alkaline phosphatase activity. The overall decrease in groundwater level from 2016 to 2020 was 5.7 m. The seed cotton yield increased by 3.2 t ha-1. The results suggest that the value of saline-alkali soil can be improved by combining Pa and Sa drainage measures. Our research provides guidance for further effective utilization of agricultural water and soil resources and the sustainable development of the soil ecosystem in arid desert areas.

Prognostic value of VISTA in solid tumours: a systematic review and meta-analysis.

In the last few years, V-domain Ig-containing suppressor of T cell activation(VISTA) has been reported as a prognostic biomarker in articles including various solid tumours. However, their conclusions have been controversial. For this reason, we performed this meta-analysis to further verify the prognostic value of VISTA in solid tumours. All relevant literature was identified from PubMed, Embase, the Cochrane Library and Web of Science. Ten studies, including 2, 440 patients, were eligible for the analysis. The pooled results showed that high expression of VISTA was associated with favourable overall survival (OS) than that seen with low expression of VISTA (7 studies, hazard ratio (HR) = 0.75, 95% confidence interval (CI): 0.66-0.86, P < 0.001). In addition, high expression of VISTA significantly correlated with high numbers of CD8 (+) tumour infiltrating lymphocytes (TILs) (3 studies, risk ratio (RR) = 1.80, 95% CI: 1.41-2.31, P < 0.001). In conclusion, these results indicate that VISTA is a potential prognostic biomarker in solid tumours.